Provider Demographics
NPI:1629751771
Name:SUPPORTIVESTEPS HOMECARE LLC
Entity Type:Organization
Organization Name:SUPPORTIVESTEPS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-806-2014
Mailing Address - Street 1:322 W LAKE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-5202
Mailing Address - Country:US
Mailing Address - Phone:207-806-2014
Mailing Address - Fax:
Practice Address - Street 1:280 PARK ST UNIT B1-1
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6521
Practice Address - Country:US
Practice Address - Phone:207-806-2014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care